Abstract 13915: Risk Factors and Outcomes of Necrotizing Enterocolitis (NEC) in Congenital Heart Disease Patients Post-intervention
INTRODUCTION: Necrotizing Enterocolitis (NEC) is a recognized complication in neonates with Congenital Heart Disease (CHD). To determine risk factors for NEC in CHD patients post-intervention (Surgical/Catheter), we conducted a retrospective matched case-control study of neonates and infants admitted to our critical care unit (CCU) from 2003 to 2010.
METHODS: All patients who developed NEC within 10 days post-intervention were included. Demographic, perinatal, perioperative, clinical and procedural data were extracted from health records and existing cardiology, CCU and cardiovascular data systems. Each case was matched to 3 control patients by postnatal age at intervention, year of operation and operative complexity. Severity of NEC was classified using the modified Bell Staging criteria. Outcomes of interest included hospital morbidity and mortality.
RESULTS: Thirty patients (60% male) developed post-intervention NEC out of a total of 1730 interventions; 33% had hypoplastic left heart syndrome, 60% had single ventricle physiology and 10% had biventricular physiology with left heart obstruction. Cases developed NEC at a median of 2.5 days post-intervention with 60% developing moderate to severe NEC (Bell Stage 2 & 3).The median gestational age of 38 wks was comparable for cases and controls. Cases had lower birth weight (2.8 vs 3.4 kg, p=0.002) and higher preoperative volume of enteral intake (100 vs 72 ml/kg/day, p=0.03). By multivariate logistic regression, lower birth weight was the single risk factor for post-intervention NEC (HR 0.27 (0.12-0.64) per kg birth weight increase above 1.0 kg; p=0.03). Cases had greater length of ventilation (7.5 vs 3 d, p=0.01) and respiratory support (10.5 vs 4 d, p=0.002) and greater length of CCU (11.5 vs 6 d, p=0.0007) and hospital stay (32 vs 16 d, p=0.0006). Preoperative and postoperative PRISM3 scores were comparable between cases and controls. Case mortality rate approached significance compared with controls (33 vs 16%, p=0.07).
CONCLUSIONS: Low birth weight and aggressive preoperative enteral feeding were significant risk factors for development of post-intervention NEC. Infants with CHD who had post-intervention NEC had significantly greater morbidity and a trend towards higher mortality.
- © 2013 by American Heart Association, Inc.